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Utilization management - Revision history
2026-04-26T19:26:06Z
Revision history for this page on the wiki
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https://wikimd.org/index.php?title=Utilization_management&diff=6531520&oldid=prev
Prab at 18:48, 18 March 2025
2025-03-18T18:48:09Z
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https://wikimd.org/index.php?title=Utilization_management&diff=6521844&oldid=prev
Prab: CSV import
2025-03-18T01:53:09Z
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<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">Revision as of 01:53, 18 March 2025</td>
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https://wikimd.org/index.php?title=Utilization_management&diff=6264232&oldid=prev
Prab: CSV import
2025-02-10T23:43:51Z
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<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">Revision as of 23:43, 10 February 2025</td>
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Prab: CSV import
2025-02-08T21:03:41Z
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<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">Revision as of 21:03, 8 February 2025</td>
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Prab
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Prab: CSV import
2024-02-25T13:44:39Z
<p>CSV import</p>
<p><b>New page</b></p><div>'''Utilization Management''' (UM) is a healthcare approach that aims to ensure the provision of necessary medical services to patients at the right time and in the most efficient manner. UM involves evaluating the necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities according to established criteria or guidelines under the provisions of an applicable health benefits plan.<br />
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== Overview ==<br />
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[[Utilization Management]] is a technique used by health insurance companies and plan sponsors to manage health care costs through the appropriate provision of care. The primary goal of UM is to ensure that all medical care is necessary and provided in the most appropriate setting.<br />
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== History ==<br />
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The concept of Utilization Management has its roots in the 1970s and 1980s when healthcare costs began to rise significantly. The need for a system to manage these costs led to the development of UM.<br />
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== Process ==<br />
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The UM process involves several steps, including pre-certification, concurrent review, retrospective review, case management, and appeals. Each of these steps involves a review of the medical necessity and appropriateness of the proposed care.<br />
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== Benefits ==<br />
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The benefits of Utilization Management include cost savings, improved patient outcomes, and increased patient satisfaction. By ensuring that care is necessary and appropriate, UM helps to avoid unnecessary costs and improve the quality of care.<br />
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== Criticisms ==<br />
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Despite its benefits, Utilization Management has been criticized for potentially limiting patient access to care and for the administrative burden it places on healthcare providers.<br />
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== See Also ==<br />
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* [[Healthcare Management]]<br />
* [[Health Insurance]]<br />
* [[Healthcare Costs]]<br />
* [[Medical Necessity]]<br />
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== References ==<br />
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<references /><br />
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[[Category:Healthcare Management]]<br />
[[Category:Health Insurance]]<br />
[[Category:Healthcare Costs]]<br />
[[Category:Medical Necessity]]<br />
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{{stub}}</div>
Prab